Bilateral TKR Where to begin, did too much?

[Tmgrl3]

Good to hear Benay. I am sleeping better but still being quite active if my day calls for it.

 

[Tmgrl3]

I’m obsessive about doing that. I have managed my diabetes for over 15 years with no insulin or oral meds. I think this is my GERD interacting with all the weeks on iron pills and the depression. In my whole life I have rarely had so poor an appetite but I am eating regular small healthy meals. Getting better and very little nausea now but not much desire to eat

 

[sistersinhim]

It is amazing how much this surgery affects every area of our body. I'm glad you're not so sick feeling now. Eating healthy means is a real benefit to healing.

 

[Atlas_aus]

Finally some good news.

Even with the insights from people on here, getting the amount of exercise and combining it with the right amount of pain relief is like achieving the holy grail.... But satisfying when you do !

Hope the Zzzzzzzzzzzzz continues to be good for you, it really does make such a difference to our lives.

 

[Tmgrl3]

Still having exhausting days! Took a long drive today..riding in car. About an hour each way and then hour there, then an errand with hubby. Felt like I was hit be a truck tonight....still have poor appetite, can’t eat much at one time. Ten pounds down from my pre-surgical weight...I am 5’10&½ inches and weight 146 pounds. So ok but don’t want to lose more. Now have small abscess on buttocks..used to get them from bike riding and switched to elliptical at home and just realized they have me back on a bike at PT...so using antibiotic ointment hoping it recedes. Dermatologist doesn’t do premeditating for any kind of skin/lancing work so waiting to hear what my OS says about need to premedicate if it needs to be cut open. Tiny so hoping it reabsorbs. No more bike. Just tired, still some depression, not much appetite but I can walk like crazy with no cane! Three months and I am told another three months or so of these kinds of days. Maybe my age too. Slower to get back energy at 76. My hip was done when I was 65. Much easier bounce back on physical and emotional level. At least no more anemia. Iron pills gone now for at least 6 weeks but stomach still fighting me. Eating three small healthy meals, some fruits. Sigh.....

 

[Tmgrl3]

An update.

I am almost 14 weeks post op. My fatigue levels during day are greatly improved. Can do more without exhaustion. Eating better. Enjoying food more. I do have some slight clicking, not painful, in left knee. That was my “better knee” before surgery but still has bit more swelling. My knees look pretty normal though.PT says it is scar tissue that happens during healing and to massage sides of that knee.

I have been reading so many threads here and see that so many people do these intensive workouts, not just at PT but at home. I would call my recovery “recovery light.” I am at 130 degrees flexion and leg still goes out flat.

I have gone to PT twice weekly since April 24. We don’t “push” anything. I get heat on both knees first, and my back since my radiculopathy flared up and my neuropathy. That is better too. Around a month ago, we figured out I had had my 10 weeks of insomnia because I did have enough pain at night (4 or so) to keep me from sleeping so went back on tramadol 50 , one at bedtime and one middle of night. Maybe I cut back on that too soon even now. I had been off tramadol, since April 21. I am sleeping, sometimes 8 to 9 hours a night but if I push it, like yesterday we added 5 pounds to each of my two machines, I had trouble lying on either side of knee to be able to sleep. Took one tramadol 50 at bedtime and took more than hour and half to fall asleep. Woke up at 5:30 and decided to just try tylenol, but couldn’t really get back to sleep. Probably should have taken half a tramadol or whole. I fight taking pain meds. Haven’t had alcohol in 29 years and although I am not worried about addiction with the tramadol, I only want to take it when I have pain but that is hard to predict since sometimes I am tossing and turning towards morning and unsure as to what to do.

My PT believes in “letting the knee heal” without using PT to push. So I do the heat, two machines, for strength only , no more ROM work since I am there. Then maybe calf stretch, perhaps 15 minutes on eliptical, but since I have eliptical at home I can do that there. I don’t do any extra exercises at home other than my eliptical but at age 76, my daily living driving , shopping, food prep, cleanup, laundry ..all the Norma stuff is pretty much enough for me I am able to live the way I used to although I used to do 45 minutes on eliptical and sometimes some band work for my upper body and back exercises for bad back of over 50 years. I have been in sports all my life, but see no value at my age in pushing myself to heal faster or to think I can go back to my fitness level of my younger years.

I DO ice at least 3 times a day sometimes more and always a final icing before bedtime. My PT stressed that. I see the surgeon in a couple of weeks. He seems pretty conservative too about not pushing, letting the knee heal, not overdoing things. I hope the scar tissue clicking goes away but it is really barely noticeable.

It seems that when I read some threads about people having regressions that they have been very aggressive with PT and exercise regimens. My surgeon really stressed that I stop ROM work since all was normal at 8 weeks, just normal ROM I need and that under no circumstances should I go past the 130 even though new prosthetics allow up to 150 because they have seen knees break down when people and/or their PTs push past that 130 mark.

I have an abscess that isn’t getting worse, is getting slightly better and am hoping that with topical antibiotic it continues to diminish. It’s from the bike work we were doing I had to give up my biking because of these abscesses, so only eliptical now. I want to avoid having it lanced and needing antibiotics for it, plus my dermatologist says he never does do premedication.

I am glad I am here at bonesmart and took to heart the early admin post about not pushing by painful workouts and PT. With a bilateral, it is natural to take longer to be able to sleep on right side since both were operated on, but I am sleeping with just a thin pillow between the knees since I am most comfortable crossing one leg over the other and sleep mostly on right side or back (on nights when side is less comfortable) . I have (in remission at present) severe atypical positional Vertigo triggered on left sleeping side since 1999 and have had three rounds of vestibular therapy. Worst and last episode was in 2010 for three months. It is central and peripheral, but ok right now and I am planing with my new love in my life of over two year now ( I had been a widow for 9) to travel again.

So that’s where I am now. My weight stabilized at 10 pounds less than presurgical, but that is my ideal weight anyhow. My diabetes of over 15 years stayed with A1C of 6 %, slightly higher than normal for me but I have never used any meds oral or insulin. Just diet and regular exercise.

When I was younger, I had a personal trainer for many years, and used to play tennis up to 10 hours a week, was a figure skater, played all sports. But at 76, I have stopped trying to believe I will ever do what I used to do and am grateful for normal daily activity levels!!

Will keep posting updates as time goes on.

 

[sistersinhim]

It sounds like you're coming along wonderfully!

 

[Tmgrl3]

13 weeks post op. First dental cleaning today. Had a toothache. Just at nights but in a tooth that has had a root canal and then, 10 years ago an apicoectomy. Used to be they could only do one apico. So....some irregularities on the x-ray and my dentist wants me to go to oral surgeon and get a 3D x-ray and opinion. If a problem, and can’t do another apico (or even if they can) it is supposed to be 6 months post op for dental “surgery.” Hoping that it isn’t anything ...but will just have to get there and check it out. If surgery is a must to remove the tooth and do an implant, my orthopedic surgeon will have to work with oral surgeon to create a plan to prevent infection. I caught C-Diff in 2006 in the hospital and was in for a month and almost didn’t make it, so antibiotics long term not good for me.

Has anyone here had oral surgery within the six month window of joint replacement ? Just the way life goes sometimes, so I will hold good thoughts and maybe it is something that can wait six months.

Seems like a lot of whammies this year. My hubby had triple lumbar fusion in September, 2018, and I waited for my Bilateral knee replacement till March. Now is may also be facing shoulder surgery, but my tooth may upstage that one.

Hope someone out there has something positive to help me with this.

 

[luvcats]

Nothing useful to add, but I am sorry you're getting hit from every direction. How stressful and unpleasant.
Have a dancing kitten.

 

[Tmgrl3]

Nothing useful to add, but I am sorry you're getting hit from every direction. How stressful and unpleasant.
Have a dancing kitten.

Thanks luvcats...I can use the cheer!

 

[Tmgrl3]

15 weeks post op tomorrow. Finally sleeping at night on back and ON SIDE! Down to just 25 mg of tramadol at bedtime and one Tylenol when I wake up during the night. I feel that good kind of tired when you finally start to sleep and want to get more. See surgeon next week for 16 week post op. Still 130 degrees and 0 degrees and working mainly on strength at PT..also get deep heat there before beginning and a massage of the knees. I do that at home too. Can do more now and not get wiped out. Appetite coming back but want to keep off that extra 10 pounds I lost. Time and patience and work...but not too hard and too much.

 

[marieltha]

Interesting, Benay, that you combine Tylenol PM (with the antihistamine benadryl in it) with Tramadol. I read (somewhere?) that Tramadol releases/increases(?) histamines , but do not know. Also read that Tramadol might suppress serotonin.

What do you think, Josephine?

(I hope I phrased all this appropriately—if not, Josephine, edit or delete at will)

 

[Benay]

@marieltha your comments were interesting. I've stopped the antihistamines (actually the Benadryl) because I read it can make restless leg syndrome worse. Didn't but should've known it was in the Tylenol PM. I've stopped taking Tramadol and now I'm taking a PM and a Naproxen at night. It's not fabulous but do-able.

I really no longer have any significant pain so probably it's enough.

One Naproxen in the morning sees me right through the day. I read in someone's post that it was really good for residual swelling which made me decide to take it. I've tried to vary the meds because I don't want to rely on any one combination.

My reasons aren't scientific but I'm basically a hater of meds of any sort so really doing my best to use as little as possible with an OK result. I've got so many Oxycontin and Tramadol left but would only use only if really needed - particularly the oxy. My doctors have been super generous.

 

[Benay]

@Tmgrl3 so pleased to read of your progress. Just great! I'm working on my 6 lbs because sadly I always had the appetite and didn't hold back being that everything else was so trying.

 

[winemama]

My first TKR I lost 25 lbs, I was ok with that. My wife is an excellent cook, she made my portions small, so I knew I was getting good food, but my cravings for sugar and fruit were off the charts. I just kept grapes and cut up fruit on my table while I iced

 

[Tmgrl3]

I believe Tramadol can boost serotonin increasing risk of serotonin syndrome. It prevents the re-uptake of serotonin therefore increasing serotonin. I have bipolar disorder and can’t use any SSRIs because serotonin and bipolar can. E a real problem. My psychiatrist and I have worked carefully together to find my balance of meds.

 

[Tmgrl3]

LOL. I put on 32 pounds of edema with my double knee. When that was gone I had lost that and 10 more pounds. Now I want to keep it off. I wasn’t really overweight for my height 5’ft 11”. 156 pounds before surgery. Now 146. Love that.

 

[marieltha]

I use a CPAP device for mild sleep apnea. So I try to monitor any effects on the AHI of medicines. Normal AHI’s are 5 and below. The Sleep Center said to expect variations after surgery, and/or when taking pain meds, and to contact my Dr if I had steady readings of 15 or higher, which I have not. Erratic, though. Felt less rested after TylenolPm, so didn’t repeat that. Since the surgeries (March knee & May shoulder) I am more sensitive to /get higher AHI’s with foods w sugar, even fruits, if eaten at dinner or in the evening. Sigh.

 

[Jockette]

So I try to monitor any effects on the AHI of medicines.

What is AHI?

 

[marieltha]

Here’s the definition the CPAP device manufacturer (Phillips) gives in their Dreammapper app:
“The Apnea–Hypopnea Index (AHI) is an index used to indicate the severity of sleep apnea. It is represented by the number of apnea and hypopnea events per hour of sleep. The apneas (pauses in breathing) must last for at least 10 seconds and are associated with a decrease in blood oxygenation. Combining AHI and oxygen desaturation gives an overall sleep apnea severity score that evaluates both number sleep disruptions and degree of oxygen desaturation (low blood level). The AHI is calculated by dividing the number of apnea events by the number of hours of sleep. With AHI, a lower number is better; any number under 5.0 is ideal. “